Lung cancer screening

For smokers, the best way to avoid lung cancer is of course to quit smoking. However, even when you have done so it may take 15 years for your risk of lung cancer to drop to that of a non-smoker, whilst the effect of cigarette smoke works its way out of your system. Screening for lung cancer has a useful role for those who remain at increased risk of lung cancer, to pick up any worrying nodules at an early stage when curative treatment may be possible.

Lung cancer screening is offered to current or recent ex-smokers in some countries including the US.  A trial of this treatment has now commenced in the UK, but availability is limited to certain geographical lung cancer hotspots, described https://www.england.nhs.uk/2019/02/lung-trucks/

Screening involves undergoing a regular CT scan every year to detect early stage cancer, usually for 15 years from the time of quitting smoking.  This is proven to reduce the death rate from lung cancer, in those at high risk.

What if I have symptoms I am worried about ?

If you have any worrying symptoms at the present time, eg a persistent new-onset cough, worsening shortness of breath or weight loss then you should speak to your doctor with a view to referral as soon as possible.  However, this does not amount to “screening”, as this term only applies to investigation of those who are believed to be well, to identify disease of which you may be at risk, but is not suspected at the present time.

Who may benefit from lung cancer screening

Trials of screening have been worthwhile for people whose risk of developing lung cancer over the next 5 years is 5% or more. A typical risk profile would include those aged 55-75, with a smoking history equivalent to 20 per day over a 30 year period.  Lung cancer risk may be calculated from a number of web-based calculators eg  https://shouldiscreen.com/English/lung-cancer-risk-calculator. Please contact us for an appointment at info@guildfordrespiratory.co.uk if you would like to discuss the value of screening in your case.

Are there any disadvantages of lung cancer screening ?

Lung cancer screening is a programme which lasts for a number of years and so involves an ongoing commitment to an annual scan.  Like any other screening programme, there would be limited benefit in just a one-off test.  Usually annual scanning is recommended until 15 years after the time of quitting smoking.

Small nodules are a  common finding on a CT scan of the lungs is, most of which turn out to be benign.  Often, these nodules are so small that the only way to determine their nature is to re-scan after a period of time, to see if the nodule has changed in any way.  Nodules which are stable over a period of time are highly unlikely to be malignant.  Nonetheless, some people will find that identification of such nodules, even though likely benign, will cause a degree of anxiety – so much so they would rather not know.  Other people would rather know and be reassured that we are keeping them under surveillance.

If nodules are a little larger, then sometimes further tests are needed, such as more detailed scans or a biopsy.  Again, some people will find the process of being investigated for such nodules rather worrying and would rather not know. Needless to say, we would recommend that those at higher risk of lung cancer are investigated, so that any worrying nodules are identified at the earliest possible stage.  If further tests are required, then the cost of these is covered by your insurance company or the NHS as needed.

Finally, a CT scan involves exposure to a very small dosage of radiation. However, the very small risk this confers (1:1000) is outweighed by the potential benefit which has been shown in large studies.